When doctors leave clinical medicine, don’t blame the victim

I don’t want to be unclear here. I don’t want to mince my words. But I’m mad about an interaction I had on Facebook. I was commenting on the Physician Side Gigs group page when someone riffed on one of my statements. They mentioned that my opinions could be a slippery slope towards a future where doctors no longer see patients. The insinuation was that we as physicians owe it to our community to continue practicing medicine. As many of you know, with my half retirement, I am planning to leave patient visits behind. Being financially independent is allowing me to escape a work environment laced with fear and anxiety. Doctors are fleeing abuse. So it really rankles me when either another physician or society as a whole shames us for wanting to escape.

It’s a classic case of blaming the victim.

Blaming the victim

There is no question in my mind that physicians are victims of a health care system gone horribly wrong. It starts with medical school and residency. Doctors in training are exposed to sleep deprivation, physical, and emotional trauma from day one. We are harangued with unreasonable expectations, placed in a silo of silence and culpability, and shamed at almost any sign of weakness.

Although it comes at a large price, the upside of this lashing is that we start our professional careers as attending physicians having reached mastery, and have acquired the emotional forbearance to face the most difficult situations.

And then systematically our mastery and autonomy are stripped away.

It’s no wonder we are leaving clinical practice. Doctors are fleeing abuse.

Mastery and autonomy

After paying such a high price to attain mastery, it is quite hard to explain how painful it is to have this mastery and autonomy pulled out from under us. Although we often have a strong sense of what our patients need to not only survive but thrive, our authority is questioned and undermined at every turn.

Insurance pre-authorization. Guidelines. Face to Face encounters. Electronic medical records. Formulary compliance. The maze of hoops to jump through is vast and time-consuming. Every medical decision is accompanied by its own requisite hurdle that often cuts our plans off at the knees as opposed to measuring appropriateness.

We are constantly questioned by administrators, nurses, and doctors in other clinical fields, that have been empowered by our system to challenge our decisions without a deep knowledge of the subject matter or even a glancing familiarity with our patients.

Our mastery is questioned, and autonomy is clipped.

There is nothing more difficult than having some third party administrator tell us we can’t use our mastery to provide desperately needed care to the patients we have vowed to protect. And then have some malpractice lawyer come after us when things go wrong.

Doctors are fleeing abuse.

Why ever would we not move towards a nonclinical career?

Escape hatch

There is this strange belief that it is the victim’s responsibility to fix the abuser. Doctors are fleeing the abuse because they have self-value. Because they value their own skills and abilities. It is lubricous to tell physicians it’s their responsibility to convince the healthcare systems to stop abusing them.

Instead we are exercising our plan B. We are quitting clinical medicine. Taking on non-clinical careers, and flexing our ability to retire early.

This is a rational response to irrational behavior by society. How could this be considered selfish?

Final thoughts

Doctors are fleeing abuse. After suffering through an inhumane training program we are thrust into the most complicated of human situations, and then systematically stripped of our mastery and autonomy. We become victims of a system motivated by politics and business, and devoid of the altruism that drove us to this profession.